Legislative Updates

Politics and Emergency Medicine – An Essential Lesson for Every Resident

Shannon Toohey, MSIV
Mark I Langdorf, MD, MHPE

University of California, Irvine School of Medicine, Department of Emergency Medicine, Orange, CA

Every year the California Chapter of the American College of Emergency Physicians (Cal-ACEP) holds a Legislative Leadership Conference in Sacramento: a day of lectures and personal visits with state senators, assembly members and their staff, which focuses on legislation impacting emergency medicine (EM). This year, as a soon-to-be EM intern, I had the opportunity to attend, and I hope the perspective I derived will stay with me for the rest of my career. The recurring theme of the conference was the critical importance of emergency physicians being politically informed and involved in order to affect laws and policies.

As someone who is not well-versed in politics, I became aware within a short period of time of how politics has a direct impact on the daily lives of emergency physicians. Several government officials and legislators spoke at the conference, including California State Insurance Commissioner Dave Jones, Secretary of California Health and Human Services Agency Diana Dooley, and Richard Pan, who talked about his experiences as a physician in the legislature.

As I listened to their comments, I became aware of our different perspectives. While state politicians focus on the big picture and their constituents, they vote on very specific legislation that if passed would dramatically affect our practice and the welfare of our patients. The most important lesson I took away from these lectures was that legislators use the information and opinions given to them by experts and advocates to form their opinions and ultimate votes. Our job as emergency physicians is to provide expert perspective to legislators and their staff on issues we grapple with every day, such as serving the homeless, disenfranchised, mentally ill, violent and intoxicated. This is where our political power as emergency physicians lies.

Speaking directly to senators and their staff was easily the most beneficial experience of the day. Those I visited – Senator Joel Anderson and the staff of Senator Lois Wolk – were receptive to the concerns of emergency physicians. However, many legislators are unaware of the difficulties faced in emergency departments (EDs). Emergency physicians know the importance of the ED safety net and the maintenance of ED funding, something we must be sure legislators understand before they vote on bills that cut our funding or on laws that would affect ED crowding.

Another important aspect of the conference is the opportunity to hear colleagues, who work diligently on current Cal-ACEP bills, and their opinions to bring certain legislation that affects emergency patients. This year, for example, the Maddy fund (a last resort safety net fund of $55 million for uninsured California patients in the ED) was summarily raided by a budget committee without public notice or comment. Furthermore, ED inpatient boarding and the resultant crowding is barely on the radar screen of some legislators, even though it is rampant in the state's overburdened EDs.

The Cal-ACEP Legislative Leadership conference is something every student, resident and physician should attend at least once. While our focus, as physicians in training, is on patient care and evidenced-based medicine, we sometimes need to look outside our practice at the external forces that affect our practice and our patients. Understanding the politics behind their practice is valuable to every physician. It is crucial to emergency physicians given how essential our practice is for public safety and how dependent we are on public funding. I know I will attend again and hopefully will do so throughout my career to help protect and guide the future of emergency medicine.

Last updated: March 8, 2013